In the present study, we have shown that the combination of 20% mannitol and 3% HS does not affect the intrinsic coagulation pathway
at doses used intraoperatively for anti-oedematous therapy according to data obtained from the InTEM analysis.
Three standard ROTEM assays were performed: intrinsic coagulation pathway
--INTEM, extrinsic coagulation pathway--EXTEM, and functional fibrinogen--FIBTEM.
Inverted and protruding nonendothelized margins from where subendothelial collagen is exposed to blood can activate platelets and the intrinsic coagulation pathway
Partial thromboplastin time (PTPT): On addition of phospholipids or surface active dispersed particles and calcium ions, thrombin formation occurs via the intrinsic coagulation pathway
In addition, all patients were screened by several laboratory tests, including measurement of the complete blood count (CBC), including platelet count; prothrombin time (PT) to evaluate the extrinsic coagulation pathway (factor II, V, VII, and X activity), which were converted to calculate the International Normalized Ratio (INR) (7); and activated partial thromboplastin rime (aPTT) to evaluate the intrinsic coagulation pathway
(factor VIII, IX, XI, and XII activity).
This fibrin clot forms via (1) the intrinsic coagulation pathway, when activated factor XII (FXIIa) binds to the exposed endothelial cells at the site of injury and (2) the extrinsic coagulation pathway, when small amounts of circulating FVIIa bind to tissue factor released from injured endothelial tissues.
The active protein in this fibrinolytic system is plasmin, which is produced as plasminogen and is activated by (1) kallikrein generated by the intrinsic coagulation pathway, (2) tissue plasminogen activator released from the injured endothelial cells, and (3) urokinase produced by kidney endothelial cells.